Lacetera Vito, Cantoro Ubaldo, Montesi Lorenzo, Cantoro Daniele, Cervelli Bernardo, Cicetti Antonio, Gabrielloni Giuliana, Milella Domenico, Montesi Michele, Morcellini Roberto, Parri Gianni, Recanatini Emilio, Beatrici Valerio
Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano.
Arch Ital Urol Androl. 2017 Mar 31;89(1):39-41. doi: 10.4081/aiua.2017.1.39.
The objective of the present study is to evaluate the diagnostic accuracy of hexylaminolevulinate (HAL) blue light cystoscopy compared with standard white light cystoscopy (WLC) in daily practice.
An observational, comparative, controlled (within patient) study was carried out at our Center. 61 consecutive patients with suspected or confirmed bladder cancer were recruited for the study from January 2008 until January 2015. Patients with suspected bladder cancer (positive cytology with negative WLC) or history of previous high-grade NMIBC or CIS were included in the study. Biopsies/resection of each positive lesion/suspicious areas were always taken after the bladder was inspected under WLC and BLC. Diagnoses of bladder tumor or CIS were considered as positive results, and the presence of normal urothelium in the biopsy specimen as negative result.
61 BLC were performed. 15/61 (24.5%) with suspected initial diagnosis of NMIBC and 46/61 (75.5%) with a history of high-risk non-muscle invasive bladder cancer (NMIBC). We performed a total of 173 biopsies/TURBT of suspicious areas: 129 positive only to the BLC and 44 both positive to WLC and BLC. 84/173 biopsies/TURBT were positive for cancer. All 84 NMIBC were positive to the BLC, while 35/84 were positive to the WLC with a sensitivity of BLC and WLC respectively of 100% and 41.7%. Sensitivity of WLC for highgrade NMIBC and CIS was 34.1% and 39% respectively while sensitivity of BLC for high-grade NMIBC and CIS was 100%. The specificity of the WLC was 79.9% compared to 48.5% of the BLC. The positive predictive value of BLC and WLC were respectively 48% (95% CI: 0.447-0.523) and 79% (95% CI: 0.856-0.734).
Our data confirm those reported in the literature: BLC increases the detection rate of NMIBC particularly in high risk patients (history of CIS or high grade). BLC is a powerful diagnostic tool in the diagnosis of bladder cancer if malignancy is suspected (positive urine cytology) and if conventional WLC is negative.
本研究的目的是在日常实践中评估与标准白光膀胱镜检查（WLC）相比，氨基乙酰丙酸己酯（HAL）蓝光膀胱镜检查的诊断准确性。
在我们中心进行了一项观察性、对比性、对照（患者自身对照）研究。从2008年1月至2015年1月，连续招募了61例疑似或确诊膀胱癌的患者进行研究。纳入研究的患者包括疑似膀胱癌（细胞学阳性而WLC阴性）或既往有高级别非肌层浸润性膀胱癌（NMIBC）或原位癌（CIS）病史的患者。在WLC和BLC下检查膀胱后，总是对每个阳性病变/可疑区域进行活检/切除。膀胱肿瘤或CIS的诊断被视为阳性结果，活检标本中存在正常尿路上皮被视为阴性结果。
共进行了61次BLC检查。初始疑似诊断为NMIBC的患者有15/61（24.5%），有高危非肌层浸润性膀胱癌（NMIBC）病史的患者有46/61（75.5%）。我们对可疑区域总共进行了173次活检/经尿道膀胱肿瘤切除术（TURBT）：仅BLC阳性的有129例，WLC和BLC均阳性的有44例。173次活检/TURBT中有84次癌症阳性。所有84例NMIBC对BLC均呈阳性，而84例中有35例对WLC呈阳性，BLC和WLC的敏感性分别为100%和41.7%。WLC对高级别NMIBC和CIS的敏感性分别为34.1%和39%，而BLC对高级别NMIBC和CIS的敏感性为100%。WLC的特异性为79.9%，而BLC的特异性为48.5%。BLC和WLC的阳性预测值分别为48%（95%CI：0.447 - 0.523）和79%（95%CI：0.856 - 0.734）。
我们的数据证实了文献报道的结果：BLC提高了NMIBC的检出率，特别是在高危患者（CIS或高级别病史）中。如果怀疑有恶性肿瘤（尿细胞学阳性）且传统WLC为阴性，BLC是诊断膀胱癌的有力诊断工具。
